Common Nail Disorders
Beau's lines: are deep grooved lines that run from side to side on the fingernail or the toenail. They may look like indentations or ridges in the nail plate.
Blue fingernails: are caused by a low level or lack of oxygen circulating in your red blood cells. This condition is known as cyanosis. It occurs when there isn't enough oxygen in your blood, making the skin or membrane below the skin turn a purplish-blue color.
Bruised nail beds or Subungual hematoma: the medical term for bleeding and bruising under the nail. This is usually the result of some kind of injury to the blood vessels under the nail bed.
discolored nails: the nails appear white, yellow, or green, and can result from different infections and conditions of the skin
Eggshell nails: A condition of your nails that causes them to appear thin, white, and brittle like that of an eggshell
Hangnail: a tiny, torn piece of skin, more specifically eponychium or paronychium, next to a fingernail or toenail. Hangnails are typically caused by having dry skin, or by trauma to the fingers, such as paper cuts or nail biting
Koilonychia: also known as spoon nails, is a nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia. It refers to abnormally thin nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape.
Leukonychia spots: a condition where white lines or dots appear on your finger or toenails. This is a very common issue and entirely harmless.
Melanonychia: a condition of either the fingernails or the toenails. Melanonychia is when you have brown or black lines on your nails. The decolorization is usually in a stripe that starts at the bottom of your nail bed and continues to the top. It may be in one nail or several.
Onychophagy: an oral compulsive habit of biting one's fingernails
Onychorrhexis: a brittleness with breakage of finger or toenails that may result from hypothyroidism, anemia, anorexia nervosa or bulimia, or after oral retinoid therapy
Plicatured nail: a type of highly curved nail plate often caused by injury to the matrix, but may be inherited;also called "folded nail"
Ridges: Vertical lines running the length of the natural nail plate, usually related to normal aging
Splinter Hemorrhage: tiny blood spots that appear underneath the nail. They look like splinters and occur when tiny blood vessels (capillaries) along the nail bed are damaged and burst.
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Definition[edit | edit source]
The Capillary refill test (CRT) is a rapid test used for assessing the blood flow through peripheral tissues. It's a quick test performed on the nail beds to monitor the amount of blood flow to tissues and dehydration. [1] The CRT measures the efficacity of the vascular system of hands and feet as they are far from the heart. [2]
Alternative names[edit | edit source]
The Capillary refill test is also called: [1]
- Digit blood flow test
- Capillary refill time
- Capillary nail refill test
Procedure[edit | edit source]
The following steps have to be followed when doing the test: [3]
Step1. Remove finger rings and nail polish.
Step2. The therapist compresses the nail bed until it turns white and records the time taken for the color to return to the nail bed.
Step3. It normally takes 3 seconds or less. When it takes longer, arterial insufficiency is suspected.
Step4. Always compare to the normal side of the hand or fingers.
Although the CRT is used in both children and adults [4], there is less literature about its use among adults [1] as well as very little research information about its validity. [5]
- Interpretation of Results
- Normal Results
The CRT is largely recommended in the routine of unwell patients and should last less < 2 seconds. If the color is pink after there is no more pressure; it indicates a good blood flow to the finger.t It's part of the assessment of patients seriously ill. [4]
2. Abnormal Results
A CRT> 2 seconds or prolonged CRT is suggestive of an early sign of shock. [5]
Several other factors can affect the CRT measurement and therefore its results. They may include: [4] [5]
- Peripheral vascular disease
- Hypothermia
- Cold ambient temperature
- Poor lighting
- Old age
- Pressure application
- Intra and interobserver reliability
The ABCDE approach used by nurses to assess and treat severely ill patients has 5 components namely: Airway, Breathing, Circulation, Disability, and Exposure. Although the CRT represents a big part of the Circulation during this assessment, a thorough examination should be done and should include:[5]
- Pulse rate
- Pulse volume
- Blood pressure
- Level of consciousness
- Skin color/ temperature/texture
- Urine output
- as well as other clinical findings of the ABCDE approach/assessment
The ABCDE assessment looks for life-threatening conditions and therefore brings lifesaving interventions to critically ill patients. [6] .
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Capillary nail refill test. Available from: //medlineplus.gov/ency/article/003394.htm (Accessed 24 October 2020)
- ↑ Capillary nail refill test. Available from: //pennstatehershey.adam.com/content.aspx?productid=117&pid=1&gid=003394 (last Accessed 25 October 2020)
- ↑ David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
- ↑ 4.0 4.1 4.2 Pickard A, Karlen W, Ansermino JM. Capillary refill time: is it still a useful clinical sign?. Anesthesia & Analgesia. 2011 Jul 1;113(1):120-3.
- ↑ 5.0 5.1 5.2 5.3 How to measure capillary refill time in patients who are acutely ill. Available from: //www.nursingtimes.net/clinical-archive/assessment-skills/how-to-measure-capillary-refill-time-in-patients-who-are-acutely-ill-20-07-2020/ (Accessed 24 October 2020)
- ↑ The ABCDE Approach for Medical students. Available from: //iem-student.org/2019/08/18/the-abcde-approach-for-a-medical-students/ ( Accessed 28 October 2020)
- ↑ Paramedics Course -Capillary Refill Time - Australian Paramedical College. Paramedical College. Available from: //youtu.be/wqaOwFI0ikI
- ↑ Capillary Refill Test. Dr. Borst's Occupational Therapy Classroom. Available from: //youtu.be/n--wFoZFklg